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• W2947356901 abstract "Purpose Interhemispheric subdural hematomas (ISH) are rare in adults and occur most often after cranial trauma. We describe a parturient who developed bilateral acute ISH after inadvertent dural puncture associated with placement of an epidural catheter for labour analgesia. We discuss the features, pathophysiology, and management of this type of subdural hematoma. Clinical features A 38-yr-old woman requested epidural analgesia for relief of labour pain. An inadvertent dural puncture occurred during placement of a 17G Tuohy needle. After labour and delivery, the patient developed symptoms of a postdural puncture headache, which responded only partially to an epidural blood patch. The patient’s headache subsequently became less positiondependent and was associated with episodes of sharp pain radiating down her legs and paresthesias on the left side of her body. A computed tomography (CT) scan showed right frontal and left parietal acute ISH without an intracranial mass effect. The patient was monitored in the intensive care unit and treated conservatively because of the relatively small size of the ISH and the absence of progressive neurological deficits on serial examinations. Daily CT scans showed gradual decreases in the size of the ISH concomitant with improvement of the headache. Conclusions Rupture of bridging veins between the cerebral cortex and the superior sagittal sinus is the usual mechanism by which ISH occur. Nearly one-quarter of patients with ISH do not survive, although those with smaller hematomas have a better outcome. If the hematoma is 1 cm in thickness, a conservative approach to ISH is recommended in the absence of mental status changes, seizure activity, or focal deficits, but with larger ISH or evidence of progressive neurological deterioration, surgical evacuation is most often required to prevent mortality. Resume Objectif Les hematomes sous-duraux inter-hemispheriques (ISH) sont rares chez l’adulte et surviennent le plus souvent apres un traumatisme crânien. Nous decrivons le cas d’une parturiente qui a presente un hematome sous-dural aigu bilateral apres ponction durale accidentelle en rapport avec la mise en place d’un catheter peridural pour analgesie au cours du travail. Nous discutons les caracteristiques, la physiopathologie et la prise en charge de ce type d’hematome sous-dural. Caracteristiques cliniques Une femme âgee de 38 ans a demande a beneficier d’une analgesie peridurale pendant le travail. Il y a eu une ponction accidentelle de la dure-mere pendant la mise en place d’une aiguille de Tuohy 17G. Apres le travail et l’accouchement, la patiente a presente des symptomes de cephalee post ponction dure-merienne qui n’ont repondu que partiellement a un colmatage sanguin (blood patch) peridural. La cephalee de la patiente est devenue ensuite moins liee a la position, mais elle a ete associee a des episodes de douleurs aigues Author contributions Mei-Ying Liang wrote the original draft of the manuscript and edited the revision. She approves the final manuscript and agrees with the submission. Paul S. Pagel edited multiple versions of the original and revised manuscript. He also collected and edited the figures for publication. He approves the final manuscript and agrees with the submission. M.-Y. Liang, MD, PhD Department of Anesthesiology, The Medical College of Wisconsin, Milwaukee, WI, USA M.-Y. Liang, MD, PhD P. S. Pagel, MD, PhD (&) The Anesthesia Service, The Clement J. Zablocki Veterans Affairs Medical Center, 5000 W. National Avenue, Milwaukee, WI 53295, USA e-mail: pspagel@mcw.edu 123 Can J Anesth/J Can Anesth (2012) 59:389–393 DOI 10.1007/s12630-011-9664-6" @default.
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• W2947356901 title "Bilateral interhemispheric subdural hematoma after inadvertent lumbar puncture in a parturient Hématome sous-dural inter-hémisphérique bilatéral après ponction lombaire accidentelle chez une parturiente" @default.
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